Braving difficult choices alone: children's and adolescents' medical decision making.

OBJECTIVE: What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. METHODS: Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. RESULTS: Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. CONCLUSIONS: Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process

FATAL FAMILIAL STEATOSIS OF MYOCARDIUM, LIVER AND KIDNEYS IN THREE SIBLINGS

A 2-day-old male and 3-day-old female child were born within the span of one year to two young and healthy unrelated parents with no history of any past illness. A third child was born two years later. After birth, the first born baby appeared well but became ill the following day with marked dyspnea, cyanosis, generalized flaccidity, bradycardia and finally total respiratory arrest. The second child suffered with an almost identical clinical picture and succumbed to its illness in a manner quite similar to that of its sibling brother. Likewise, the third child at the age of seven months became apathic, cyanotic and dyspneic. It died ten minutes after arrival in the hospital in a state of unconsciousness. Autopsies of all siblings demonstrated very similar macroscopic and microscopic findings of a peculiar diffuse intense fatty degeneration of the liver and myocardium with focal renal tubular epithelial involvement. Apparently, all three siblings suffered with and died of a type of fatal steatosis affecting some of the most important organs of the body

Hyperthermia and postmortem biochemical investigations.

The postmortem diagnosis of heat-related deaths presents certain difficulties. Firstly, preterminal or terminal body temperatures are often not available. Additionally, macroscopic and microscopic findings are nonspecific or inconclusive and depend on survival duration after exposure. The diagnosis of hyperthermia is therefore essentially based on scene investigation, the circumstances of death, and the reasonable exclusion of other causes of death. Immunohistochemistry and postmortem biochemical investigations have been performed by several authors in order to better circumstantiate the physiopathology of hyperthermia and provide further information to confirm or exclude a heat-related cause of death. Biochemical markers, such as electrolytes, hormones, blood proteins, enzymes, and neurotransmitters, have been analyzed in blood and other biological fluids to improve the diagnostic potential of autopsy, histology, and immunohistochemistry. The aim of this article is to present a review of the medicolegal literature pertaining to the postmortem biochemical investigations that are associated with heat-related deaths